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Sunday, March 2, 2014

Sunday's Video of the Week: Why Jones Fractures have Poor Blood Supply

The right foot is highly inverted as it strikes the ground right on the fifth metatarsal without much shoe protection.

  This is a wonderful video on the anatomy of proximal fifth metatarsal fractures. It wonderfully explains the poor blood flow to the area we call a "Jones Fracture" making it hard to heel. It does not explain that due to the attachment of major tendons and ligaments at the base of the fifth metatarsal (peroneus brevis, peroneus tertius, and 4/5 metatarsal base ligament attachments) the area to one side of the Jones Fracture  is very solid. The area just distal to these attachments, towards the toes, where you get the Jones fracture is a highly stressed area (more relative motion/stress with loading of the fifth metatarsal head). The area in front of an immobile area has more mobility, and in this area, can break easier and take longer to heal. 

     Podiatists also have many tricks to help these bones heal, and minimize or eliminate the need for surgery and/or non-weightbearing. Custom made functional foot orthotic devices can be made to off weight and stabilize the fracture (this has to be built into the design--you can not assume your orthotic device has this function). See some of my posts on orthotic modifications for supinators. Kinesiotaping of the midfoot can immobilize the fracture area and decrease the stresses.

 The use of removable casts with off weighting techniques (ample use of 1/2 inch adhesive felt with cut outs) or ZeroG removable boots with EvenUps can get a better result that the weakness of non-weightbearing. Exogen bone stimulators are vital is the healing of these fractures and are used for 9 months. Designing return to activity programs with the above minimizes the de-conditioning that can occur. From the day you broke your foot, you could be on a stationary bike for 1-2 hours with the weight in the heel. 

    What are other areas of concern? Of course with any bone injury, bone density and Vit D3 levels are important. Making sure you are getting 1500 mg of calcium and 1000 units of Vitamin D. Making sure that your shoes do not break down to the outside and you have become too inverted/supinated.

Remember that your treatment regimen is between you and your physician. The more you learn, the better questions you can ask, and ultimately, the faster you will heal. 

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.